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HIMSS 6. EXPERIENCIA CLINICA LAS CONDES
Santiago, Chile
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Neurosurgeon In love with computers since Medical School. (Atari, Mac, PC, Linux, Mac again) Image processing and research in fMRI CLC Executive Committee until 2011 Chairman Department of Neurosurgery until June 2012 CMIO CLC since September 2011
Dr. Jose Miguel Selman
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September 2014 468 staff doctors 320 beds Will have 500 beds in 2016
Founded in 1982 50% doctors owned 255 beds in 2009 16 operating rooms 236 outpatient clinics Emergency Service 16000 surgeries annually Certificated by The Joint Commission
• Abril 2008. Reunión de lanzamiento del proyecto
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Equipo Directivo CLC
Comité DOC
Médico Líder
Requerimien
tos de las
distintas
especialidad
es médicas
Enfermera
Líder
Requerimientos
de enfermería
Arquitecto de
Integración
Implementación tecnológica de todos los requerimientos. Control de avances
Reporte de solicitudes y alternativas de solución
Medición de Impacto, toma de decisiones, definición de prioridades, definición de ruta del proyecto.
Reporte de avance del proyecto.
The Project (Millenium Version 2007.17)
• Text
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From the Doctors Perspective
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Used as a paper chart. Only clinical notes. Nobody grasped the concept of structured information. The GUI is horrible. Looks like Windows 3.1!!! Beta software… Primitive text processing!!! No back button. My diagnoses don’t exist in those lists!!! I can’t see the previous diagnoses in those lists !!! A thousand clicks for the most trivial of tasks!!! Drug reconciliation doesn’t work!!! Bad use of my time!!! ETC...
January - April 2011 Verbal orders.
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Indicator: Outpatient visits with coded diagnosis
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Everett Rogers Diffusion of Innovations 1962
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Doctors by percentage of
Outpatient diagnoses
First quarter 2012
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You’ve Led the Horse to Water, Now How Do You Get Him to Drink ?
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¿?
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Go on vacation
It can be changed It can be good Get rid of what is not working Concentrate on CPOE
The light, or “how to change an opinion in one afternoon"
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Tony Ruiz CIO
Jean-Jaques Rajter CMIO
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CMIO
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Motivations for Doctors
Time Safety of the medical act
Benefit to the patient
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Practical Actions
Convince everybody that the EMR was good and usable Meeting with all the Departments explaining the importance of Diagnosis and Problems list and how to manage them in a structured manner. Creation of a local Thesaurus and expanding it as suggestions arrived Get rid of what is not working
Alarms Drug reconciliation Dissolution of the Medical Committee.
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Collective Instruction with all the Departments in Diagnoses and Problems lists
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First ten months
Actions
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Ad a QF to the team Multum pharmacological information and progressive addition of alerts Pharmacy specialist training course Sentences, sentences, sentences TallMan for LaSa Contextual help Video training Prescription by active principle and not by brand
Build CPOE from zero
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POCMAR
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SDD (Sistema de Digitalizacion de Documentos)
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Improved patient care Quick access to patient records from anywhere, inside or outside the Campus, even in situations of crisis.
Enhanced decision support, clinical alerts, reminders, medical information
Performance improving tools, real time quality reporting
Legible complete documentation
Interfaces with labs, registries and other EHRs
Safer, more reliable prescribing
Objectives of an EMR
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Improved care coordination
•Better integration through improved information sharing •Viewable and up-to-date medication and allergy lists •Order entry at point of care •Standarization of data, order sets and care plans •Better transitions between care settings
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Management Protocols
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Powerplans
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Estimado Dr(a). SELMAN ROSSI, JOSE MIGUEL El protocolo operatorio de la cirugía efectuada con fecha 05/03/2015 12:43 a su paciente, el Sr(a) XXXXXXXXXXXXXXXXXXX, no se encuentra disponible en la ficha clínica electrónica, o no se encuentra en un episodio correcto por lo que no es accesible a quien lo necesita. Le agradeceremos resolver esta situación a la brevedad. Cirugia : BIOPSIA ESTEREOTAXICA Atentamente Comité Ficha Clínica
ATENCION: Dr(a). JOSE MIGUEL SELMAN ROSSI El examen radiológico realizado a su paciente, el Sr(a) XXXXXXXX, tiene resultado CRÍTICO y se encuentra disponible para su revisión, ha sido informado por el radiólogo AYALA DIAZ,SILVIA LILIANA , según lo definido por el protocolo. A través de este mail reiteramos información dada telefónicamente sobre el diagnóstico de su paciente. El examen se encuentra disponible en Ficha DOC, en DPI o en el visualizador de imágenes PACS de CLC .
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Better efficiencies and costs savings
Example A pilot study was done to analyze the movement of PRN drugs, that need to be reintegrated to the stock after being dispatched and not used. It showed that at least 60 man/ hours per week were wasted for returning those drugs to the stock. We changed the dispatch to just one dose per day. Now we are conducting a broader study to see if we can afford the instalation of Pyxis.
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SERVICIO
CLÍNICO
1°
SEMESTRE
2011
2°
SEMESTRE
2011
1°
SEMESTRE
2012
2° SEMESTRE
2012
1°
SEMESTRE
2013
2°
SEMESTR
E 2013 1° SEMESTRE 2014
%
INDICACION
ES
ESCRITAS
%
INDICACION
ES
ESCRITAS
%
INDICACION
ES
ESCRITAS
%
INDICACIONE
S ESCRITAS
%
INDICACION
ES
ESCRITAS
%
INDICACI
ONES
ESCRITAS
%
INDICACI
ONES
ESCRITAS
TOTAL
INDICACI
ONES
GINECO-
OBSTETRICIA 12.87% 16.25% 45.33% 52.85% 60.72% 68.35% 65.41% 16044
CEVIM 21.40% 26.71% 54.97% 69.81% 85.25% 82.95% 88.76% 4662
HEMATO-
ONCOLOGÍA 32.33% 34.29% 79.51% 80.58% 70.86% 78.27% 66.26% 25275
UCC 46.48% 48.69% 96.51% 99.57% 98.79% 98.67% 98.16% 24027
INTERMEDIO
CORONARIO 44.94% 41.93% 96.15% 98.61% 98.08% 98.67% 98.63% 31703
MQ 31.13% 32.71% 77.20% 81.16% 77.84% 75.73% 75.43% 42644
NEO UTI 88.47% 88.19% 99.44% 98.92% 99.25% 99.41% 99.47% 6422
NEO
INTERMEDIO 75.90% 78.50% 98.54% 99.42% 98.11% 99.13% 99.19% 3071
NEO SALA CUNA 95.59% 91.66% 94.23% 93.72% 93.99% 8702
PEDIATRÍA MQ 19.16% 24.22% 81.66% 88.33% 90.15% 94.90% 89.15% 470
PEDIATRÍA
INTERMEDIO 29.29% 44.14% 89.31% 93.79% 95.48% 97.01% 96.62% 13021
PEDIATRÍA UTI 19.05% 41.41% 93.46% 94.63% 94.93% 96.79% 96.34% 10257
UTI 18.52% 13.39% 77.80% 84.25% 76.26% 76.72% 73.38% 40297
UCI 29.02% 37.24% 90.85% 93.76% 93.54% 94.64% 93.66% 30955
INTERMEDIO
NORTE 31.34% 38.20% 92.80% 93.73% 95.27% 94.37% 93.85% 14330
RECUP GO 94.36% 2836
RECUP AMB 90.88% 1984
RECUP CPA 90.92% 13113
RECUP CENTRAL 89.50% 200
TOTAL CLC 27.34% 30.32% 82.97% 86.78% 85.20% 86.65%
84.93
% 271880
Ord
ers
en
tere
d d
irectl
y b
y t
he p
rovid
er
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Doctors by outpatient diagnoses 2014
<80%
0
40
80
120
160
91-100% 81-90% 71-80% 61-70% 51-60% 41-50% 31-40% 7 21-30% 11-20%
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Proud of bringing Latin America into HIMSS Map
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Where are we heading now?
Managing growth Personnel training Creating mPages (v5). Specialty pages (Playbooks) Dynamic documentation Patient Portal Datawarehousing with BO and SAP. Better knowing our patients needs through information.
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Intensive Care Unit
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C.A.R.E. Centro de Analisis y Razonamiento Estrategico (Strategic Analysis and reasoning)
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Sala C.A.R.E. Centro de Analisis y Razonamiento Estrategico
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Sala C.A.R.E. Centro de Analisis y Razonamiento Estrategico
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CMIO
